The Truth About ‘Boosting Your Immunity’

Coronavirus information changes quickly, so please note the publication date on this story. You can find current recommendations and national outbreak data on the CDC website. Or, if you want local coronavirus updates, check out the department of health website for your state or your city. Enjoy reading and stay safe.

If you check the news or scroll through social media right now, there’s a good chance you’ll see something about products, foods and drinks that boost immunity. One articlesays to try elderberry syrup, another suggests boiling garlic and others recommend loading up on vitamin C. There’s nothing wrong with adding an herb to your morning smoothie, and vitamin-rich fruits and vegetables have unequivocal health benefits. It’s also natural to seek out ways to protect yourself from getting sick during a global pandemic. But don’t let promises of immune-boosting cure-alls give you a false sense of invincibility — or make you waste money.

“You cannot boost immunity by just taking one or two things,” says Dr. Sean Leng, a professor of medicine, molecular microbiology and immunology at Johns Hopkins Medicine. “These things probably don’t hurt, but they’re not going to ‘boost’ your immune function overnight. The immune system is a very complicated system, as all systems in the body are.”

The immune system has two parts: the innate immune system and the adaptive immune system. The innate immune system includes our skin and the linings of our lungs and gut, all of which create physical barriers to keep pathogens (anything that causes disease) from entering the body. It also includes cells called macrophages and neutrophils that recognize pathogens and produce other molecules to attack the invader. “This isn’t pathogen-specific,” Leng explains. “You could have bacteria, the influenza virus or COVID-19 enter the body, and these cells will attack all of those.”

On the other hand, the adaptive immune system consists of T and B cells, which fight off specific pathogens, the collective term for viruses, bacteria, fungi and other types of microorganisms that can cause disease. It’s “adaptive” because these cells only evolve once you’ve encountered and recovered from a pathogen.“If you have a virus, after the infection clears, your body develops specific T and B cells against that particular pathogen so that it will be able to respond in a much stronger fashion the next time it encounters the virus,” Leng says. “The B cells produce antibodies to go out and neutralize the virus, and the T cells are cellular immunity. Those kill the other cells that are infected by the virus so the virus will not survive” in your body.

Although genetics influence our immune response, our individual life experiences and environments also play a big role. “Our immune system is constantly shaped by what we are exposed to,” says Dr. Dawn Bowdish, Canada Research Chair of aging and immunity at McMaster University. If we have been exposed to certain pathogens in our environment, then we’re more likely to develop specific immunities to them. In the case of COVID-19, humans had never been exposed to the virus before this outbreak, so no one had built immunity to it. That’s one reason it’s become such a widespread pandemic.

Explainers

Lifestyle factors such as smoking, being inactive, eating an unhealthy diet and excessive drinking can also compromise the overall immune system. And “as we age, immune function declines,” Leng says, which may partly explain why older adults seem more susceptible to becoming severely ill from COVID-19.

All of these variables cause each of us to have different responses to different viruses. Some people can be exposed to the coronavirus and not be infected; some people will be infected but have no symptoms; some will develop symptoms but be able to manage them at home, and some will become very sick and need to be hospitalized.

In some cases, serious cases of COVID-19 are actually caused by the immune system overreacting. “A strong inflammation response fights infections, but in COVID-19, part of what is killing people is a strong immune response,” Bowdish says. At the onset, COVID-19 attacks the lungs, where it replicates and travels deep into the lungs. The immune system responds by releasing pro-inflammatory cytokines and other cells. But in some people, this reaction goes too far, setting off what’s called a cytokine storm. “The immune system is out of control,” Leng says.

The resulting inflammation damages the air sacs, which leak liquid in the lungs. “Water in the lungs happens very deep with this virus,” Bowdish explains. “That’s why so many need ventilator support. It’s just like drowning. Your lungs can’t get oxygen, and the heart compensates by beating harder and harder and harder and faster.” This acute respiratory distress syndrome can lead to death.

An overactive immune system can also lead to autoimmune disorders like lupus and rheumatoid arthritis as well as asthma. So if “boosting” the immune system means increasing the response, that’s not necessarily a good thing. Additionally, “the immune system does so much; some features that might be good for one thing might be bad for another,” Bowdish says. “I don’t know what ‘boosting’ would mean.”

However, there are proven ways to support a healthy immune system. “We need a good immune response against pathogens so that when a virus comes to attack us, it will kill the virus,” Leng says. “But when people talk about one food or a quick fix, that will not help, because the immune system needs to be maintained and fostered for longer periods of time. It builds up over the years.”

The first thing both Bowdish and Leng recommend is regular physical activity. A sedentary lifestyle is associated withimpaired immune response. One reason may be that sitting appears to increasemarkers of inflammation. “Exercise is nature’s anti-inflammatory,” Bowdish says. “Moving and exercise can help support the health of multiple organs so the body can invest less energy in repairing those organs and more energy doing what it needs to do.”

While you can forget about any magic supplement or other quick fix to “boost” your immunity, don’t forget about about the known ways to protect yourself against the coronavirus: Social distancing is critical, so stay home as much as possible, and when you do venture outside to exercise or visit the grocery store, stay at least six feet away from other people. COVID-19 can live for up to 24 hours on cardboard and up to three days on plastic and stainless steel, so wash your hands regularly. Lastly, if you do start to exhibit symptoms, call your doctor. Only go to the hospital if you have severe symptoms, Leng says. Globally, we may still be working on our immune response, but individually, there’s still plenty that’s within your control.

Brittany Risher is a writer, editor and digital strategist specializing in health and lifestyle content. She's written for publications including Men's Health, Women's Health, Self and Yoga Journal.

I take a biologic injection called Tremfya every two months. It has done wonders for controlling my psoriasis – especially when it turned into a very serious type called erythrodermic psoriasis. However, I skipped my last injection in part because I had a stomach ache and not knowing what it was due to and in part because of fear of covid-19. I wonder if I made a mistake doing that as I’ve read that this could cause flare-ups. Is it possible that this injection might actually make covid-19 less severe should I get it by fighting of a cytokine storm? Any thoughts on that?

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For people with irritable bowel syndrome, it’s common to hear that symptoms such as cramping, alternating diarrhea and constipation, and bloating are “all in their head.” In the case of IBS, there’s actually some truth to this.

It’s not that their symptoms don’t exist. IBS is a very real disorder, and managing its physical toll often becomes an all-consuming effort. The litany of concerns that accompany so many activities — always scouting the closest bathroom, making sure you can reach it in time, farting in public — keeps many people with IBS from having a social life.

Yet according to some experts, IBS is not solely about what’s going on in the digestive system; rather, the brain exacerbates the condition. “IBS is a disorder of brain-gut dysregulation,” explains GI psychologist Sarah Kinsinger, who is also co-chair of the psychogastroenterology section of the Rome Foundation. Accordingly, addressing the “brain” side of IBS through cognitive behavioral therapy with a trained psychologist may help decrease both the anxiety that’s often associated with the disorder and its physical symptoms.

“CBT really should be the first-line treatment for people with IBS. It’s the treatment with by far the most empirical support, and when done well, it can be curative,” says Melissa Hunt, associate director of clinical training in the psychology department at the University of Pennsylvania.

In a series of trialspublished last year, researchers in the UK compared the standard treatment for IBS (typically diet and lifestyle modifications and/or medication) with eight sessions of CBT delivered over the phone or online. Before and after the trials, participants answered questionnaires designed to measure their anxiety, depression and ability to cope with their illness. Two years after the trials, 71 percent of the phone-CBT group and 63 percent of the online-CBT group reported clinically significant changes in their IBS symptoms. Meanwhile, less than half of the standard-treatment group reported such an improvement. Those who did CBT also exhibited lower levels of anxiety and depression and higher coping ability than other participants.

In an earlier meta-analysis (a study of studies), published in 2018 in the Journal of Gastrointestinal and Liver Diseases, a different team of researchers also found that CBT appeared to reduce both psychosocial distress and the severity of IBS symptoms, with a greater effect on the physical symptoms than on the mental ones.

Explainers

The brain-gut connection

How this happens is not completely clear at this point, but it’s believed to have something to do with how the gut and brain communicate.

“IBS is thought to be a disorder of centralized pain processing,” Hunt explains. “There is miscommunication between the pain centers in the brain and the nerves in the gut. In people with IBS, pain signaling gets inappropriately amplified.” Discomfort that wouldn’t even register in the majority of people feels like being stabbed in the gut to a person with IBS. “The best way to address that is to find ways to help reduce pain signaling, and that’s with a psychologist,” Hunt says.

CBT for IBS entails learning relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, which help reduce the “volume” of the pain signals by activating the parasympathetic nervous system, i.e., the body’s “rest and digest” response. “This can also lead to increased blood flow and oxygen to the digestive system, which helps the GI tract to function in a more rhythmic way,” says Kinsinger, who is also an associate professor at Chicago’s Loyola University Medical Center.

CBT also involves thought restructuring. IBS can cause a cycle of worry: Worrying about symptoms leads to being hyperfocused on the slightest hint of any symptom, which increases anxiety, which aggravates symptoms. People with IBS also often catastrophize, meaning they assume the worst will happen (“If I have an accident at work, I’ll get fired and never get another job”), develop social anxiety and become withdrawn. CBT addresses these issues by shifting attention away from IBS symptoms and using exposure therapy to help people gradually engage in more activities outside their homes.

Additionally, using CBT, people with IBS learn to identify and change dysfunctional ways of thinking. For example, consider someone with school-aged children who asks their spouse to attend all school functions because they’re afraid of farting in a room with other parents, which would inevitably cause humiliation and might even make people think they’re disgusting A therapist might ask them how often they notice bodily noises from other people to help them realize that we’re a lot more cognizant of our own bodily functions than other people are. “In other words, we identify the catastrophic beliefs and then search for evidence supporting them or not,” Hunt says.

CBT is a skills-based, goal-oriented approach to treating mental disorders that emerged in the mid-20th century. All CBT programs share the same underlying goal of helping patients identify and modify negative or unhelpful thought patterns and behaviors. “It teaches patients techniques that they can then implement on their own.” says Kinsinger. “It can be done pretty efficiently, depending how motivated and receptive one is to learning these skills.” But over time, customized versions of CBT have been developed for specific conditions including insomnia, schizophrenia and IBS. Different versions of CBT use different techniques, such as role-playing, exposure therapy and relaxation exercises, and vary in length. On average, CBT for IBS lasts between 4 and 10 sessions in total.

Jeffrey Lackner, professor and chief of the division of behavioral medicine at the University at Buffalo, SUNY, says their program is structured like a course: “You learn a specific skill to manage your GI symptoms, process information differently or respond to stress in a less extreme way. Then you practice that skill in session before using it in the real world.” Often therapists also give patients homework to fine-tune the skills they learn. They come out of CBT with a toolbox of techniques to manage the day-to-day burden of IBS.

Some people with IBS do CBT on their own, using self-help books, online materials or apps without ever seeing a therapist. “Not many psychologists are trained to treat GI disorders specifically, so physicians don’t often have anyone to refer patients to,” Kinsinger says. The Rome Foundation trains psychologists and maintains a directory of gastrointestinal psychologists, but if someone can’t find a provider in their area, Hunt and Kinsinger recommend looking for a psychologist who’s trained in CBT and has experience treating chronic pain, panic disorders or anxiety.

Reducing sensations vs. reducing sensitivity

Not everyone is fully on board with CBT for IBS. One 2018 review study found “insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases” including IBS. A different 2018 review concluded that although psychological treatments for IBS appear to help in clinical trials, it’s unclear if they work in other settings and which treatments — such as CBT, mindfulness-based stress reduction and guided affective imagery — are most effective.

IBS is a complex problem, and some doctors prefer to integrate CBT with other treatments. But “by the time we see them,” Lackner says, “many of our patients have found that the medical treatments have not provided adequate symptom relief.”

Some IBS patients also find thetraditional approaches too hard to stick with. The most commonly prescribed treatment is a “low-FODMAP” diet, which requires giving up all dairy and legumes, plus many grains, fruits and vegetables. “Some trials show that even if the diet reduces or eliminates GI symptoms, it doesn’t improve quality of life because it’s crazy restrictive,” Lackner points out.

“With IBS, the nerve endings in the gut have become hypersensitized, and the brain magnifies those signals in the gut,” Hunt says. “The low-FODMAP diet tries to reduce the sensations, whereas CBT reduces the hypersensitivity. When you turn down the volume on the sensations, then you can eat whatever you want.”

Whether CBT helps with this brain-gut dysregulation, addresses distorted thinking and anxiety, or increases confidence in a person’s ability to manage gastrointestinal symptoms — or all of the above — it’s helped people with IBS resume parts of their life they’d put on hold.

Brittany Risher is a writer, editor and digital strategist specializing in health and lifestyle content. She's written for publications including Men's Health, Women's Health, Self and Yoga Journal.

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